Doctors writing in the journal BMJ Case Reports warn of the dangers associated with complementary therapies after a 4-year-old boy with autism was admitted to accident and emergency following advice to take holistic supplements.

Upon admission, the young boy had a range of symptoms, including vomiting, constipation, weight loss, and loss of appetite. Doctors performed a number of tests which revealed hypercalcaemia--a high level of calcium in the blood--as well as a high level of vitamin D.

Several days after admission, the mother revealed she had consulted a naturopath who had recommended for the boy to take 12 holistic supplements, including calcium, vitamin D, cod liver oil, camel milk, silver, zinc and epsom bath salts.

In view of other investigations being normal, doctors thought that the supplements he was taking were the most likely explanation for his symptoms.

"His parents were devastated that something they had given to their son with good intent had made him so unwell....The police became involved to investigate the naturopath who had advised the therapies," they explain.

He was treated with hyperhydration and medications to reduce his calcium level, and he made a full recovery two weeks later.

"Many families view these therapies as safer 'natural' options," they say. "But as this case demonstrates, there can be significant adverse effects which may go unrecognised due to lack of monitoring, recognition and experience with these therapies."

"There are many reported cases of complications, including fatalities, and probably many others which are not reported to medical practitioners or recognised as being attributable to these."

Complementary and alternative medicines use is highly prevalent among children with chronic illnesses, including autism, for a number of reasons.

These can include dissatisfaction with conventional treatment, the belief that alternative therapists consider the more emotional and psychological aspects of care, and parents having a greater sense of empowerment by choosing what treatments to give their child.

BMJ Case Reports publishes the case of a middle aged women with Rapunzel syndrome--an extremely rare condition in which the body of the hairball lies in the stomach, and its tail extends to the intestines.

The condition is associated with trichotillomania, where patients have an irresistible urge to pull out one's hair, and trichophagia, the compulsive eating of hair. It's named after the long-haired girl named Rapunzel, in Grimm brothers' fairy tale.

The woman aged 38 years had nausea, sudden vomiting and constipation, and had an enlarged abdomen due to accumulating gas and fluids.

She vomited everything that she tried to eat, had an unintentional weight loss of 15 pounds over the last 8 months, and significant loss of appetite for the last 12 months. She looked tired and had an unhealthy pale appearance.

A number of tests were inconclusive as to the cause, and additional tests could not be performed due to the patient's worsening condition.

Doctors decided to operate, and surgery revealed a 15×10 cm hairball in the stomach with a small tail in the first part of the intestines, and a separate mass of hairball measuring 4×3 cm in the third portion of the intestines (see figures).

Both hairballs were removed and the patient was discharged after 6 days. The patient was managed with the help of a psychiatrist and was given nutritional support.

In addition to reporting on this case, the group of US doctors reviewed 88 cases of Rapunzel syndrome, highlighting the rarity of the condition.

They found that the condition is most commonly seen in children and adolescents, is associated with an underlying psychiatric disorder, and document complications from untreated cases, and recommend treatments.

A common yet potentially life threatening bacterial illness transmitted by ticks was responsible for a woman developing seizures and multiorgan failure.

The previously healthy 66-year-old woman living in the Mid-Atlantic USA presented to the hospital with lethargy, loss of control of bodily movements, and slurred speech. Two weeks before, she had removed a tick from her right groin following a holiday in Hawaii.

She reported malaise, fevers, diarrhoea, and a cough. Physical examination revealed a rash on her chest, and abnormal rattling sounds in her lungs.

Initially, doctors started antibiotic treatment for pneumonia. However, she was transferred to intensive care for progressive respiratory failure, declining mental status and seizures.

Tests revealed the bacteria, Ehrlichia Chaffeensis, in the patient's blood, confirming diagnosis of human monocytic ehrlichiosis--the most common life threatening tick-borne illness in the USA. Fatality rates range from 3-5%.

The patient made a complete recovery after 10 days with appropriate antibiotic treatment.

The doctors who treated the patient published their report in the online journal BMJ Case Reports.

BMJ Case Reports is an award winning journal that delivers a focused, peer-reviewed, valuable collection of cases in all disciplines so that healthcare professionals, researchers and others can easily find clinically important information on common and rare conditions. This is the largest single collection of case reports online with more than 11,000 articles from over 70 countries. For more information, visit: http://www.casereports.bmj.com

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